warfarin and Gingival-Hemorrhage

To explore the influence of the single use of perinatal warfarin anticoagulation therapy on pregnancy outcome after the mechanical heart-valve replacement surgery in pregnant women.. Fifty-eight cases of pregnant women after heart-valve replacement surgery (2005.1-2009.12) received low-dose warfarin anticoagulation therapy. The perinatal outcomes included: (1) maternal complications: thrombosis, hemorrhage, heart failure, etc., and (2) adverse perinatal outcomes: miscarriage, stillbirth, neonatal death, fetal malformation, preterm delivery, such as warfarin syndrome.. In 58 patients, valve thrombosis was found in one case of pregnancy, general hemorrhage was found in 16 cases, spontaneous abortion was found in two cases, malformation was found in two cases. There were no stillbirth and neonatal death. Three cases were premature delivery. Thirty-two of 56 cases were late pregnancy vaginal delivery. Twenty-four cases were cesarean section produced, in which heart failure happened in 1 case and late postpartum hemorrhage happened in one case.. The low-dose and low-intensity warfarin anticoagulation therapy during pregnancy is good for patients with good compliance and low rate of fetal malformations and can effectively prevent maternal complications.

Topics: Abortion, Spontaneous; Adult; Anticoagulants; Aortic Valve; Cardiac Valve Annuloplasty; Cesarean Section; Congenital Abnormalities; Delivery, Obstetric; Ecchymosis; Epistaxis; Female; Gingival Hemorrhage; Heart Valve Prosthesis; Humans; Mitral Valve; Pregnancy; Premature Birth; Thrombosis; Warfarin; Young Adult

In patients on high-level anticoagulant therapy (prothrombin time-international normalized ratio [PT-INR] ≥ 4.5), surgical procedures can be carried out with bridging therapy using heparin. However, surgical treatment options are severely limited in patients on high-level anticoagulant therapy and who have heparin-induced thrombocytopenia (HIT), as heparin use is contraindicated. We performed tooth extraction using prothrombin complex concentrate (PCC) in 2 HIT patients on high-level anticoagulation therapy (PT-INR ≥ 4.5). Five hundred units of PCC were administered intravenously, and after 15 minutes, it was confirmed that PT-INR was less than 2.0. Tooth extraction was then performed and sufficient local hemostasis was achieved. At 3 hours after tooth extraction, PT-INR was 2.0 or higher and later increased to 4.0 or higher, but postoperative bleeding was mostly absent. When performing tooth extraction in HIT patients on high-level anticoagulant therapy, favorable hemostatic management was achieved through sufficient local hemostasis and transient warfarin reversal using PCC.

Topics: Adult; Aspirin; Blood Coagulation Factors; Blood Loss, Surgical; Cellulose, Oxidized; Contraindications; Electrocoagulation; Female; Fibrinolytic Agents; Gingival Hemorrhage; Heart Failure; Heart-Assist Devices; Hematoma; Hemostatics; Heparin; Humans; International Normalized Ratio; Male; Molar, Third; Periapical Periodontitis; Pericoronitis; Plasma; Postoperative Hemorrhage; Prothrombin Time; Thrombosis; Tooth Extraction; Tooth, Impacted; Warfarin

We retrospectively investigated hemostatic management for periodontal treatments in patients on oral antithrombotic therapy.. A total of 155 periodontal treatment procedures were performed in 139 patients who continued taking conventional antithrombotic drugs. Insertion of oxidized cellulose, compression, and suturing were used as local hemostatic measures. When hemostasis was difficult, hemorrhage was stopped using electrocautery and/or splint.. For the warfarin patients, 49 scaling procedures were performed in patients with INR of 4.82 or less, and 52 periodontal surgeries were performed in patients with INR of 2.97 or less. As for periodontal surgeries, electrocautery and splint were used in 30% and 70% of cases, respectively. In the entire patient population, posttreatment hemorrhage was seen in 2 (1.3%) of the 155 periodontal treatment procedures.. Scaling can be safely performed in patients on warfarin (INR <4.0) and/or antiplatelet therapy. Periodontal surgery can be performed in patients with INR less than 3.0 with proper local hemostatic procedures.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dental Prophylaxis; Drug Therapy, Combination; Female; Fibrinolytic Agents; Gingiva; Gingival Hemorrhage; Hemostasis, Surgical; Humans; Male; Middle Aged; Periodontal Diseases; Platelet Aggregation Inhibitors; Retrospective Studies; Warfarin; Young Adult

In this study, patients with heart diseases were classified into 2 groups: Warfarin user and Warfarin non-user, and six salivary components were determined to assess intraoral pathologic conditions. Groups of healthy subjects and patients with periodontal disease without receiving any medication were set as control groups, and they were compared with those of the 2 groups with heart diseases. In patients with heart diseases in both the groups, albumin (ALB) level was found to be significantly higher compared to that in the control groups, and it was significantly higher in the patient group receiving Warfarin user and Warfarin non-user compared to that in the patient group with periodontal disease. C-reactive protein (CRP) levels were found to be higher in both the groups with heart diseases than those in the healthy group. Correlations between various salivary components and the clinical parameters were examined, showing significant correlations between ALB and gingival index (GI) and clinical attachment level (CAL), and between alanine aminotransferase (ALT) and GI, probing depth (PlI), bleeding on probing (BOP) and CAL. Significant correlations were also found between creatine kinase (CK) and PlI, GI and BOP. Thus, it was suggested that ALB and CRP might serve as the markers of intraoral pathologic conditions, and CK and ALT might serve as those alternative to GI.

Topics: Adult; Aged; Alanine Transaminase; Albumins; Anticoagulants; Aspartate Aminotransferases; Biomarkers; C-Reactive Protein; Cardiovascular Agents; Creatine Kinase; Dental Plaque Index; Gingival Hemorrhage; Heart Diseases; Humans; Middle Aged; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Saliva; Salivary Proteins and Peptides; Warfarin

Topics: Acetaminophen; Aged; Analgesics, Non-Narcotic; Anticoagulants; Drug Interactions; Female; Gingival Hemorrhage; Hematuria; Humans; International Normalized Ratio; Phytotherapy; Warfarin; Zingiber officinale

Topics: Acenocoumarol; Administration, Oral; Aged; Anticoagulants; Blood Proteins; Drug Administration Schedule; Drug Synergism; Erectile Dysfunction; Gingival Hemorrhage; Half-Life; Heart Valve Diseases; Humans; International Normalized Ratio; Male; Piperazines; Postoperative Complications; Protein Binding; Purines; Ranitidine; Sildenafil Citrate; Sulfones; Thrombosis; Warfarin

The purpose of the present work was to observe local hemostatic function during dental surgery in patients under oral anticoagulant therapy with an INR between 1.7 and 2.5. Thirty seven dental treatments were performed in 15 patients. Group A: nineteen dental treatments (13 scalings, 1 root canal therapy and 5 dental extractions), treated with oral rinse with tranexamic acid (250 mg dissolved in 10 ml of water). Group B: eighteen dental procedures (13 scaling, 1 root canal therapy and 14 dental extractions), in which oral rinse was utilized. Antibiotics were indicated for those patients with root canal therapy or with signs of infection. A cool soft diet was recommended to all patients during the three days following the surgical procedure. Only in five (13.5%) dental extractions (1 from group A and 4 from B) bleeding prolonged was observed, however periodontal disease was also present in those patients hone of them required blood products or withdrawal of the anticoagulant. The results suggest that mouth washing with tranexamic acid prevents excessive oral bleeding in patients treated with oral anticoagulants with an INR between 1.7 and 2.5.

Topics: Anticoagulants; Antifibrinolytic Agents; Blood Coagulation Disorders; Blood Loss, Surgical; Dental Scaling; Drug Evaluation; Gingival Hemorrhage; Gingivitis; Hemostasis, Surgical; Humans; Mouthwashes; Periapical Abscess; Periodontitis; Postoperative Hemorrhage; Root Canal Therapy; Tooth Extraction; Tranexamic Acid; Warfarin

Topics: Adult; Drug Interactions; Epistaxis; Female; Fluconazole; Gingival Hemorrhage; Humans; Melena; Warfarin